CARTA AL DIRECTOR

What could happen to Oral and Maxillofacial Surgery, Stomatology, and Odontology with the development, possibly uncontrolled, of implantologic or similar therapies? Likewise, what could happen to medicine and its specialties?

¿Qué le puede pasar a la Cirugía Oral y Maxilofacial, a la Estomatología y a la Odontología con el desarrollo, quizá incontrolado, de las terapias implantológicas o similares así como de forma parecida a la medicina y a sus especialidades, en los aspectos que les correspondan a cada una de ellas?

Mr. Director:

We are concerned about how «Implantologic Science» and its numerous «scientists» are encrouching on the traditional fields of oral and maxillofacial surgery, stomatology, and odontology, etc.

Generally wrapped in a mantle of aggressive marketing, of which they are, unfortunately, probably unaware of themselves, they encourage others to embark on a similar path. We believe that it is our duty to remind them of the basic disciplines and procedures, which undoubtedly are strongly oriented toward practical skills but still backed by an important body of scientific work, so that these colleagues remain within the bounds of professional courtesy.

What we want to make clear is that, for us it is much more difficult to be a good oral and maxillofacial surgeon, ear, nose and throat specialist, or, above all, stomatologist or odontologist than to be a «good implantologist.» (The use of this term is questionable because, at least in Spain, it has no legal definition.) Nowadays, it seems as if the specialist who labors to obtain a good clinical history, perform a meticulous physical examination, and apply proper prophylactic and conservative treatments, is a creature of the past. We would like to gently remind our fellow professionals in this letter that if they are intent on pursuing this course, they should proceed with caution and not stray from the foundations that sustain these specialties. Our obligation is to help our patients to stay healthy using the simplest and most elemental procedures. In passing, we would like to note, in case anyone is unaware of the fact, that the "simplest and most elemental procedures" are generally more difficult to perform than a dental implant or two. Our first obligation is to put off the need for implants or extraordinary therapeutic measures of any type without harming the patient and using conventional procedures. We insist that to do this, one must be a very good oral and maxillofacial surgeon, stomatologist, odontologist, or general physician, which is very difficult (we have always said, almost since we were students, that we have known very good physicians and general surgeons, but almost no good general odontologist or stomatologist). This is because it is hard, one would say almost impossible, for a single person to excel in the different and very complex disciplines that make up the study and treatment of dental pathology. Note that we refer only to dental pathology. Not only that, but very few professionals seem to want to excel as generalists.

Implant surgery has more commercial value than achieving a perfect bite, a good root canal, just as, to cite another type of example, performing a coronary bypass is more profitable than helping a patient to stop smoking or, even better, never start smoking. It is clear that we tend to take the easy way, whether as professionals or patients, meaning that we lean toward implants or bypasses. Both professional and patient get caught up by the current (few patients come from the stomatologist or odontologist boasting that they have received a conservative treatment, but they are quick to talk about undergoing implants or, sometimes, a root canal, they are proud of undergoing rehabilitation of their own teeth after previous conservative treatment or receiving several stents, etc).

It is said that Spain is one of the countries in Europe where more implants are performed. Is this something to be proud of, or just the opposite? This is probably due to the fact that not enough conservative stomatology and odontology is carried out. Moreover, our consumer society prefers quick, risky and costly procedures over the meticulous and exacting practice of a careful odontologist or stomatologist. These specialists not only see their work taken lightly, but also receive less compensation for it.

However, this trend is true not only for the buccal field that occupies us here. We all know that Spain (one of the noisiest nations) is one of the countries where more kidney and heart transplantations are performed and where there are more donors. Is this good as well? We beg to differ! What is really necessary is to educate the community to act more responsibly. The community must be aware each citizen is fundamentally responsible for taking care of their own health and that no government can assume the individual responsibilities that correspond to each home and individual as a primary obligation of the government.

Another point is whether patients who meet the elemental objectives of taking care of their health should receive any part of the savings that this represents for the account that they pay into and that is safeguarded and administered by governments to provide the services they need. The patient who fails to take responsibility for his or her health should somehow be obliged to pay more, in a way that remains to be determined, and the person who has behaved responsibly with respect to his or her health should be rewarded. Only in this way would it be possible to achieve a suitable and adequate public health program to cover those diseases and situations for which we are blameless, without, of course, leaving out anyone who has not taken care of his or her health as they should.

As we mentioned when we were speaking of implants, primary care and health should be supported and reinforced. Patients and professionals should be given the means to receive information and trainingto ensure adequate care to prevent primary diseases. This that should be taught and practiced, as we said before, in every home, school, workplace, university, and even street, not as campaigns but as an ongoing daily effort. By preventing disease, in most cases we avoid pathologies that are more serious, difficult to cure, and extraordinarily expensive. Such expenses sometimes seem to serve to capitalize personal or political interests.

At present, we have the feeling that the hospital, investigator, or other person who has performed the most surprising and wonderful operation in the universe, or has achieved a possible advance, is rewarded and publicized. In contrast, the citizen who takes care of his or her health and the doctor who takes care of the citizen without fuss is overlooked and goes unrewarded.

Citizens, professionals, and authorities must each comply with our primary responsibilities. It would be better to have fewer implants and fewer transplants, and more of the purest and most excellent health and primary care.

If we were to meet these goals, we probably would be much closer to answering the question with which we began this letter.

Prof. Dr. F. Hernández Altemir¹, Dra. Susana Hernández Montero²,
Profesora Dra. Sofía Hernández Montero³, Profesora Dra. Elena Hernández Montero⁴

¹Facultad de Ciencias de la Salud y del Deporte Licenciatura de Odontología de Huesca.
Colaborador Extraordinario de la Universidad de Zaragoza. Licenciado Médico Estomatólogo y Médico Especialista en Cirugía Oral y Maxilofacial
²Médico Odontólogo. Práctica Exclusiva en Endodoncia. Presidenta Nacional del XXVI Congreso de la Asociación Española de Endodoncia
³Directora Academia del Master Oficial de Implantología Dental y Prótesis Implantosoportada de la Universidad Alfonso X el Sabio de Madrid. Licenciada Médica Odontóloga y Médica Especialista en Cirugía Oral y Máxilofacial
⁴Prof. Superior de Piano y Música de Cámara. Facultativo Médico Especialista en Otorrinolaringología del
Hospital de Viladecans y del Instituto de Neuro-Otología García Ibáñez de Barcelona.